CMS Gearing Up for Mandatory Insurance Reporting

CMS will implement mandatory insurance company reporting: GHP January 1, 2009 and liability insurance carriers (workers’ compensation) on July 1, 2009. Mandatory reporting announcements will be posted on the CMS web site and e-mail notices may be requested by e-mail

The new provisions for Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers' Compensation found at 42 U.S.C. 1395y(b)(8):

Add reporting rules; do not eliminate any existing statutory provisions or regulations. The new provisions do not eliminate CMS' existing processes if a Medicare beneficiary (or his/her representative) wishes to obtain interim conditional payment amount information prior to a settlement, judgment, award, or other payment.

Include penalties for noncompliance.

Who must report: "an applicable plan." "…[T]he term 'applicable plan' means the following laws, plans, or other arrangements, including the fiduciary or administrator for such law, plan or arrangement: (i) Liability insurance (including self-insurance). (ii) No fault insurance. (iii) Workers' compensation laws or plans."

What must be reported: the identity of a Medicare beneficiary whose illness, injury, incident, or accident was at issue as well as such other information specified by the Secretary to enable an appropriate determination concerning coordination of benefits, including any applicable recovery claim.

When/how reporting must be done:

• In a form and manner, including frequency, specified by the Secretary.

• Information shall be submitted within a time specified by the Secretary
after the claim is resolved through a settlement, judgment, award, or other
payment (regardless of whether or not there is a determination or
admission of liability).

• Submissions will be in an electronic format.